Healthcare Provider Details

I. General information

NPI: 1508539271
Provider Name (Legal Business Name): EDDAH KINYUA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 NORTH ST STE A
GREEN COVE SPRINGS FL
32043-2939
US

IV. Provider business mailing address

2460 OLD MOULTRIE RD STE 1
ST AUGUSTINE FL
32086-4198
US

V. Phone/Fax

Practice location:
  • Phone: 904-284-3061
  • Fax:
Mailing address:
  • Phone: 702-645-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number828065
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11021334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: